Impaired fasting glucose is comparable to diabetes mellitus in predicting mortality and cardiovascular events in patients undergoing peritoneal dialysis: the role of β-cell function and insulin resistance.
Impaired fasting glucose in patients on peritoneal dialysis is associated with mortality and cardiovascular risks similar to those seen in diabetes mellitus.
Where it sits
this study against the rest of the erythropoietin (epo) corpusSummary and findings
This study evaluated the cardiovascular and mortality risks associated with impaired fasting glucose (IFG) compared to diabetes mellitus (DM) in patients undergoing peritoneal dialysis (PD). A total of 216 patients were stratified by glycemic status, and outcomes were assessed over a median follow-up of 41 months. The findings indicated that IFG independently predicted major adverse cardiovascular events and all-cause mortality, with risks comparable to those observed in DM.
Abstract
Peritoneal dialysis (PD) disrupts glucose metabolism due to repeated exposure to glucose-based dialysate. This prospective cohort study evaluates whether impaired fasting glucose (IFG) confers cardiovascular and mortality risks comparable to those of diabetes mellitus (DM) and to analyze the contributions of β-cell dysfunction and insulin resistance (IR) in patients undergoing PD. 216 patients receiving PD in Taiwan were stratified by baseline glycemic status into normal fasting glucose (n = 71), IFG (n = 58), and DM (n = 87). β-cell function was assessed using the Homeostasis Model Assessment of β-cell Function (HOMA-β), while IR was evaluated using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and the triglyceride-glucose (TyG) index. The primary outcomes were all-cause mortality and 3-point major adverse cardiovascular events (3 P-MACE). Over a median follow-up of 41 months, 69 deaths (32%) occurred; 42% and 38% were attributed to cardiovascular and infectious causes, respectively. Survival curves for IFG and DM were nearly superimposable, and both were worse than that for normal glucose. In fully adjusted models, IFG independently predicted 3 P-MACE (sHR, 4.00; 95% CI, 1.50-10.66; p = 0.006) and all-cause mortality (HR, 2.48; 95% CI, 1.16-5.32; p = 0.02), with risks comparable to those observed in DM. The TyG index independently predicted both outcomes, whereas greater β-cell function was associated with a reduced risk of both endpoints. These findings suggest that cardiovascular and mortality risks in IFG are comparable to those in DM among PD patients, potentially mediated by β-cell dysfunction and increased IR.
Background
This paper addresses the impact of impaired fasting glucose (IFG) on mortality and cardiovascular events in patients undergoing peritoneal dialysis (PD). Prior research has established that diabetes mellitus (DM) is a significant risk factor for these outcomes, but the role of IFG has been less clear. Understanding whether IFG poses similar risks as DM in this population is crucial for risk stratification and management.
Methods
This prospective cohort study included 216 patients receiving PD in Taiwan, stratified by baseline glycemic status into normal fasting glucose (n=71), IFG (n=58), and DM (n=87). The primary outcomes were all-cause mortality and 3-point major adverse cardiovascular events (3P-MACE). β-cell function was assessed using HOMA-β, while insulin resistance was evaluated using HOMA-IR and the triglyceride-glucose index.
Results
Over a median follow-up of 41 months, 69 deaths (32%) occurred, with survival curves for IFG and DM being nearly superimposable. In fully adjusted models, IFG independently predicted 3P-MACE (sHR, 4.00; 95% CI, 1.50-10.66; p=0.006) and all-cause mortality (HR, 2.48; 95% CI, 1.16-5.32; p=0.02).
Interpretation
The findings suggest that IFG poses cardiovascular and mortality risks comparable to those of DM among patients undergoing PD. While the statistical significance of the findings is clear, the clinical significance may be limited by the relatively small sample size and potential confounding factors. This study adds to the literature by highlighting the importance of monitoring IFG in this patient population.
Key findings
- 69 deaths (32%) occurred over a median follow-up of 41 months.
- IFG independently predicted 3-point major adverse cardiovascular events (sHR, 4.00; 95% CI, 1.50-10.66; p=0.006).
- IFG independently predicted all-cause mortality (HR, 2.48; 95% CI, 1.16-5.32; p=0.02).
- 42% of deaths were attributed to cardiovascular causes.
- Survival curves for IFG and DM were nearly superimposable.
Limitations
- observational design limits causal inference
- small sample size may affect generalizability
- potential confounding factors not fully controlled